Liposuction does not achieve metabolic benefits of weight loss

A recent study of liposuction did not find an impact on blood
pressure, plasma glucose and lipid concentration (1), whereas these
effects are obtained by weight loss following exercise or diet. The
scientists argue that the discrepancy reflects that a negative energy
balance has the main effects on the metabolic risk factors (2).
We offer another interpretation. Intra-abdominal fat can be centrally
involved in the pathogenesis of the metabolic syndrome and its metabolic
coronary risk factors. This interpretation explains both why weight loss
have effects, and why they are absent following liposuction that only
reduces subcutaneous fat.
This interpretation is supported by our own research (3). We undertook a
cross-sectional study of the relation between four measures of obesity
(body mass index, waist-hip ratio, body fat percentage measured using a
DEXA scanning, and extent of intra-abdominal fat measured using a slice of
a CT scanning of the abdomen) and metabolic coronary risk factors of the
metabolic syndrome (systolic and diastolic blood pressure, fasting serum
concentrations of high-density lipoprotein (HDL) cholesterol,
triglycerides, glucose, and plasminogen activator inhibitor 1. In multiple
regression analyses, only the extent of the intra-abdominal fat had a
significant association with these metabolic coronary risk factors. The
association was linear over the whole range of values for the
intraabdominal fat. The difference for the median values of systolic blood
pressure and HDL cholesterol between small and large values for the intra-
abdominal fat was clearly clinically relevant (1 mmol/L for HDL
cholesterol, 20 mm Hg for systolic blood pressure). The intra-abdominal
fat explained 10 to 25 percent of the variation for the metabolic coronary
risk factors. In this study, measurments of the subcutaneous abdominal fat
tissue had no significant impact on the metabolic coronary risk factors.
Thus, intra-abdominal fat had robust effects on the metabolic
abnormalities. It remains speculative whether a negative energy balance in
itself will provide additional effects.

References
1. Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, et al.
Absense of an effect of liposuction on insulin action and risk factors for
coronary heart disease. NEJM 2004;350:2549-2457.
2. Gottlieb S. Liposuction does not achieve metabolic benefits of weight
loss. BMJ 2004;328:1457.
3. von Eyben FE, Mouritsen E, Holm J, Montvilas P, Dimcevski G, Suciu G,
et al. Intra-abdominal obesity and metabolic risk factors: a study of
young adults. Int J Obes Metab Rel Disord 2003;27:941-949.

Competing interests:
None declared